MARKET WATCH
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A PET/CT volume rendering created with free OsiriX software from the University Hospital of Geneva Switzerland fuses anatomic and metabolic information. |
Although start-up costs are expensive, digital imaging technology offers impressive advantages over conventional radiology equipment. It allows radiologists to zoom, pan, tilt, and adjust contrast of diagnostic images. Because film-processing time is eliminated, the technology makes images quickly available to radiologists. Digital images can be sent via a network for remote diagnosis, and can be archived on compact optical disk or digital tape drives, saving tremendously on the storage space and labour needed to maintain traditional film libraries.
Decades ago, computer technology innovation paved the way for computed tomography (CT) and magnetic resonance imaging (MRI). More recently, digital technology has led to such applications as multidimensional imaging, computer-aided diagnosis (CAD), single-photon-emission computed tomography (SPECT), and hybrid photon-emission tomography and computed tomography (PET/CT). Using digital technology, “modern radiology can produce three-dimensional images, multimodality images, and time sequences of three-dimensional images,” explains Kathrin Lauckner, production manager from Seleon GmbH (Freiburg, Germany). Whereas traditional CT could only produce image slices of the body, new technologies such as cardiac CT can pinpoint blockages and show the heart beating in three dimensions. PET/CT brings functionality to CT scans that can be used to precisely locate tumours. SPECT uses radiopharmaceuticals to provide 3-D images of the brain, heart, other internal organs, and the skeleton. CAD shows promise in helping radiologists locate tumours that would otherwise be missed by conventional imaging modalities. Approximately one third of all mammograms now have their second read conducted by CAD, which is not only much cheaper than a reading by a radiologist, but potentially more accurate as well.
The Price of Pixels
Digital technology makes possible rapid advances in radiology, but not without cost. Diagnostic imaging companies typically spend vast sums of money on research and development, which often translates to the high final-product cost of filmless radiology equipment. Advanced imaging procedures are experiencing double-digit price inflation. Consequently, small treatment centres with tight budgets often lack the patient volume to make the technology economically feasible in the short term. That is especially true in Europe, where clinics generally have less funding than in the United States. These high-end machines are cost-prohibitive for much of the European market, including Spain and France and most countries in Eastern Europe.
While some costs for digital technology, especially computed radiology (CR) equipment, have fallen in recent years, radiology centres going filmless must purchase digital workstations and network technology that is able to handle high-resolution and multidimensional images. “Advancing healthcare technologies such as CT and MRI are generating greater numbers of images per procedure at an increasingly rapid pace,” explains Mercury Computer (Chelmsford, MA, USA) spokesperson Leigh McLeod. “This poses a tremendous challenge in terms of the display and management of medical imaging data.” A 2000-slice CT of the body generates about 1 GB of data. Archived collections of these images are frequently measured in terabytes (1 terabyte equals 1024 GB).
In order to manage the large files produced by filmless radiology systems, a group of radiologists and academics developed PACS (picture archiving and communication system) in the early 1980s. Now widespread in the United States, adoption of PACS varies from country to country in Europe. “We don’t have precise figures, but we would say that one-third of European hospitals have made the transition to PACS,” explains Patrick Koch from Kodak Health Group (Hemel Hempstead, Herts, UK), a company that offers digital imaging products ranging from PACS to digital radiography (DR) systems. “Obviously, it can vary from country to country and by type of hospital,” he adds. “More than 50% of teaching and university hospitals probably use PACS.”
Typically integrated with a radiology information system to manage patient data and images, a full PACS links radiology information to the hospital information system (HIS) network. In addition to boosting hospital efficiency, the system links patient information to the radiology department, giving radiologists quick access to patients’ medical history. Web-enabled PACS allows healthcare professionals to load patient data and treatment information from any networked treatment facility.
Despite its advantages, France and Germany have limited amounts of money available for the technology. “France and Germany have been a little bit slow in adopting PACS,” explains Koch. “This is probably a result of the configuration of healthcare there—they are very much consolidated, and they want to allocate the healthcare that they have.” Germany’s hospital funding has remained static for several years. Only about 10% of the country’s approximately 1000 hospitals with full radiology departments have installed PACS, according to Claus Schwing from Klinik Management Aktuell, a journal on the German healthcare industry.
Analogue equipment is still popular in areas where funding is tight because of its durability and relatively low cost. “People were saying five years ago that the market for x-ray film would collapse, but the total volume of film is peaking worldwide,” notes Koch. He predicts that the market for film will soon begin dropping a few percentage points, and then fall more quickly. But he concludes, “it will still take many, many years before film is completely replaced in my opinion.”
The Future of Diagnostic Imaging
In Europe, the movement to digitize diagnostic imaging is closely tied to the movement to boost healthcare efficiency through the digitization of healthcare records. Scandinavia is leading the way. “More than 90% of hospitals in Norway, Sweden, and Finland are using a digital environment,” notes Koch. Geographical regions closely following the Nordic countries include the Benelux countries and the United Kingdom. “Benelux is very digital right now,” observes Koch. Other areas, including Southern and Eastern Europe, are following suit: “What we see in Eastern Europe are the very early stages of adoption,” Koch says. “I would say Spain and Italy are also accelerating their move to digital imaging,” he adds.
As a result of steadily increasing digital business, radiology equipment manufacturers that once had significant involvement in film and film-related technologies are investing in alternative digital technologies. Kodak CEO Antonio Perez has stated that conventional film will soon be an insignificant part of its business, and predicted that by 2008, 80% of its revenue will come from digital products and services. Fuji Film (Paris) has deemphasized film as well; its medical division now offers a range of digital x-ray, digital mammography, and PACS equipment. The company reported increased earnings at the end of 2005—largely stemming from increasing sales in digital markets. Siemens (Berlin) also has invested heavily in digital imaging technology, and won Frost & Sullivan’s innovation award in 2005 for introducing the 64-slice CT system. This year, it won Frost & Sullivan’s Medical Imaging Growth Award for its diagnostic imaging product line. While most medical institutions have yet to upgrade to 64-slice CT scanners, the manufacturers are currently working to introduce 256-slice systems.
The technology is evolving so quickly that it is not certain to what extent hospitals and treatment centres are willing to pay for the latest technology. Because innovation relies greatly on funding, large companies with flexible budgets for research and development own a sizable percentage of the market. This trend will apparently continue, as even large manufacturers are consolidating resources to remain competitive. Kodak announced earlier this year that it is considering selling its medical group or partnering with another firm.
A growing number of hospitals are networking to share patient data, and are budgeting increasing amounts of money for IT technology. Digital technology is contributing to growth in radiology centres by letting radiologists read diagnostic images from a large network of imaging centres. As growing numbers of radiologists join together to read networked images, they can offer collaborative and subspecialty diagnosis.
Improving Disease Detection
The demand for high-tech radiology equipment is also supported by the need for early diagnosis for cancer and obesity-related disease. Obesity and related cardiovascular diseases are on the rise in Europe, and an increasing number of the continent’s retiring baby boomers are paying for medical services, including advanced diagnostic imaging, that are not always supported by public healthcare.
A further incentive to digitize is that diagnosing the diseases early significantly improves survival rates. A study of 42,760 women performed by the American College of Radiology Imaging Network found that digital mammography is more successful at detecting tumours than conventional mammography. Radiologists using digital mammography can magnify the images and can better view dense breast tissue that is problematic to view with conventional technology. Digital mammography also enables computer-aided diagnosis and teleradiology.
The growth in digital imaging is also contributing to the growth of telemedicine. Hailed as the wave of the future for years, remote diagnosis is becoming a reality as treatment centres network their health records and diagnostic images. Although the number of completely digital hospitals is still small, they are becoming more closely linked, often speeding diagnosis and expanding the reach of radiology specialists.
A market report from Frost & Sullivan predicts that computer systems used for disease detection and results archiving will be the fastest-growing category of the imaging market, constituting 21% of the market in 2009, up from 14% in 2004. Systems whose sales are expected to grow most rapidly include computed radiography and direct digital radiography units, 64-slice CT scanners, 3.0-Tesla MRI scanners, and multimodal SPECT/CT and PET/CT scanners.
The digital imaging shift is costly, but the technology saves treatment centres money on film and labour, and is responsible for new imaging possibilities. In addition, advanced diagnostic imaging often can be used to prevent costly and life-threatening problems such as strokes and heart attacks by enabling physicians to treat symptoms early, before they worsen. According to a recently published book, The End of Medicine: How Silicon Valley (and Naked Mice) Will Reboot Your Doctor (New York: Collins, 2006) by Andy Kessler, advances in digital imaging and other technologies could redefine the US$1.8 trillion healthcare business. Kessler argues that although digital imaging technology such as 64-slice cardiac CT is expensive, its cost pales in comparison to heart attack treatment, for instance. As the cost of silicon technology falls, so will the price of digital imaging procedures, making preventive treatment through radiology economically feasible for insurance companies and government healthcare programs. The New England Journal of Medicine chose medical imaging as one of the most important innovations of the past 1000 years. Thanks to digital imaging, the potential of radiology seems practically limitless—if the funds are available to support it.
Positron Emission Mammography Technology Promotes Accuracy
A 3-D, limited-angle reconstruction algorithm developed by Seleon (Freiburg, Germany) for the positron emission mammography (PEM) scanner offers an in-plane 1.5 × 1.5-mm spatial resolution. In contrast to whole-body PET scanners, PEM uses a partial-ring scanner, which reconstructs images from a data set with missing projections. The images produced with the algorithm have sufficient resolution for diagnosis of early ductal carcinoma.
The algorithm is being used in a scanner from Naviscan PET Systems (San Diego, CA, USA), which has low attenuation, high sensitivity for the emitted radiation from the breast, and spatial resolution exceeding that of clinical PET. Cleared by the US FDA, the scanner images the breast under mild compression with radiopharmaceuticals. The PEM scanner reportedly can be used to reduce the false- positive rate of mammography, which is estimated to be at 7–15%.
MRI-Compatible Biomedical Devices Minimize Image Distortion
A firm has developed a patented MRI-safe motor that works by subjecting a threaded nut to ultrasonic vibrations, causing the shaft to rotate and translate in the axial direction. Achieving nanometer precision, the Squiggle motor from Biophan Technologies (Rochester, NY, USA) is constructed of nonmagnetic ceramics and other advanced materials that can be accurately imaged with MRI. The motor is suitable for use in remote-controlled robotic surgical devices for MRI-guided procedures that require highly precise positioning under real-time visual control, such as intracranial procedures that require medicine to be injected into brain tumours. The motor is reportedly five times more efficient and 10 times more precise than comparable electromagnetic motors. Because it requires no gear reduction, a significant source of failure and malfunction is eliminated, increasing the motor’s dependability. A variety of models are available, ranging in size from 4 to 12 mm diam.
The company also offers an extensive portfolio of MRI-compatible biomedical devices, including stents, catheters, and guidewires. Using thin-film nanomagnetic and carbon composite coatings, the devices from the company also minimize image distortion when used with the imaging procedure.
PACS Software Facilitates 3-D Imaging
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The program offers full viewing and diagnostic functionality, high image quality, and short loading time for multithousand-slice images. The software archives and distributes digital images, ensuring secure and timely information distribution within and outside the network. The module acts as a DICOM server with online storage capability. To heighten security, the module includes user management and user-level access controls. Security features include user authentication, secure data transmission through SSL encryption, configurable user permissions, and audit trails. The software also can be used to export patient data to a CD-ROM.
Superluminescent Light-Emitting Diodes Provide Clear Images in Optical Coherence Tomography
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Owing to their high output power and large bandwidth, and high suppression of second coherence peaks, SLEDs produce spectra showing a clean Gaussian shape with low ripple values. Offering high resolution and fast scan times, the SLEDs are available at 750, 850, and 1300 nm.
Exalos designs and develops optoelectronic devices, often by way of strategic relationship with key suppliers. The company can scale manufacture to meet low- and high-volume requirements. All products are designed and manufactured to relevant ISO 9001:2000 standards, and the company is certified to ISO 9001:2000.
DICOM Media Appliance Enables On-Demand Recording
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The company also offers a line of medical-grade, archive-quality media including CD-R, DVD+R, DVD-R, and DVD-RAM. CD and DVD media are tested for compatibility with DICOM records. The company’s medical-grade DVD media feature a hard coating that reportedly offers 100 times greater scratch resistance than standard medical DVDs. The coating can help cut maintenance costs of optical library systems because its antistatic qualities reduce dust accumulation.
Ultrasound Imaging Software Enhances Picture Quality
Software that offers speckle reduction and image enhancement for a range of ultrasound systems is compatible with both PC- and DSP-based platforms. Available from ContextVision AB (Kista, Sweden), GOPView US reduces noise and speckle in real time, while simultaneously enhancing edges and fine structural details. The software maintains the look of conventional ultrasound imaging while boosting the operator’s diagnostic confidence and reducing eye fatigue. GOPView US is designed to work with all imaging modalities including colour, Doppler, 3-D, and 4-D. The software is said to have the fastest adaptive image enhancement and speckle reduction algorithm available for ultrasound imaging. Software for CT, MRI, and digital x-ray is also available from the firm.
Sputtering System Can Be Used to Coat Digital X-Ray Screens
A sputtering system is suitable for producing essential thin-film coatings for digital radiography diagnostic equipment. Available from KDF (Rockleigh, NJ, USA), the KDF 744NT sputtering system uses the physical vapour deposition technique to coat digital x-ray screens.
The system is equipped with a high-vacuum load lock and substrate preheat feature, which facilitate high throughput. The small-footprint unit has a pallet area of 19 × 19 in. Company representatives in Europe and Asia provide on-site service and software enhancement.
Connectors Are Suited for Ultrasound Scanners
Connectors suitable for ultrasound scanners and other medical imaging systems can be used to link equipment to computers for digital imaging diagnostics. Redel connectors from LEMO (Ecublens, Switzerland) use a push-pull latching system to provide a secure connection. The connectors do not require additional space or clips on the outer shell of the connector and are available in a range of colours. The connectors are offered with single and multiple coaxial cables.
Field-Programmable Gate Arrays Quicken Medical Imaging Computations
Field-programmable gate arrays (FPGAs) suitable for accelerating digital medical computations are available from Vmetro (Oslo, Norway). The Xilinx Virtex-5 family of FPGAs can be used to provide high performance and high gate density using minimal power. The process technology used to fabricate the chips has been reduced from 90 nm in the previous generation to 65 nm. High-density connectors enable a large amount of data to be fed through the units.
When compared with the Virtex-4 product family, the new-generation arrays feature improvements in processing speed and routing architecture. In addition, the product family offers a 35–40% reduction in dynamic power consumption without affecting static power consumption. The arrays have fast access to multiple banks of QDR SRAM and DDR SDRAM. High-performance SelectIO technology provides the interface between the package pins and the internal configurable logic, supporting 1.2- to 3.3-V I/O signaling with on-chip differential terminations. Digitally controlled impedance technology is used to provide active terminations, providing temperature/ voltage compensation and optional series or parallel terminations. Memory interface support is also included.
Laser Diode Features High Output Power
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Slip Rings Based on Passive Optical Technology Are Developed for CT Systems
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“When we introduced a [noncontact] system that achieved a 2-Gbit/sec transmission rate, a customer replied that he would never need it,” recalls managing director Kurt Dollhofer. “Three months later, we received his enquiry for a 5-Gbit/sec rate.” Now with GigaFOS technology, Schleifring hopes to keep its customers satisfied for years to come.
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Schleifring’s worldwide market share of slip rings used in CT systems currently exceeds 90%, according to the company. Over the years, the firm has evolved from a components manufacturer to a supplier of subsystems that include the complete data transmission technology.
